2002 OPEN FORUM Abstracts
EVALUATION OF THE EFFICACY OF RESPIRATORY THERAPISTS TO SAFELY INSERT PERIPHERALLY INSERTED CENTRAL CATHETERS (PICC).
Frank Miller, RRT, Jeanine Moorhead, RRT, Cheri Schuler, RRT, RPFT, Mayo Clinic Hospital, Phoenix, AZ.
Background: Peripherally inserted central catheters (PICC) have typically been inserted by physicians and specially trained nurses. In 1998, with only two nurses trained to insert PICCs, our institution created a Venous Access Process Improvement (PI) team to evaluate the need to develop and expand the current PICC team. The Venous Access PI team considered respiratory therapy as a potential resource, but recognized two limitations license restrictions and lack of training. Practice limitations were addressed with the Arizona Board of Respiratory Care Examiners, who determined that PICC insertion is within a respiratory therapist?s scope of practice. Training of respiratory therapists included attending an extensive 8-hour theoretic and practical education program, followed by clinic demonstration and competency evaluation. Once both limitations had been resolved, a core group of respiratory therapists were introduced as members of our PICC team in 1999.
Method: Retrospectively we reviewed the charts of 1,295 patients having a PICC inserted either by a respiratory therapist, registered nurse, or physician for infection over a 2 year time frame. Respiratory therapist and registered nurse PICC insertions were performed at the patient?s bedside utilizing a chest x-ray to verify proper placement. Unsuccessful placement of a PICC, by a PICC team member, was referred to a physician who inserted a PICC utilizing fluoroscopic imaging to verify placement.
Results: Out of the 1,295 patients having a PICC inserted, 337 were inserted by a respiratory therapist, 790 were inserted by a registered nurse, and 168 unsuccessful insertion attempts being referred to a physician for insertion. There were 7 infections (0.5%) associated with the insertion of the PICC, 5 infections from the 790 PICCs inserted by registered nurse (0.6%), 2 infections from the 168 PICCs inserted by physicians (1.2%), and zero infections from the 337 PICCs inserted by respiratory therapist (0.0%).
Conclusions: Respiratory therapists that receive specialized training, equal to the training a registered nurse, can safely insert a PICC without increasing the risk for infection.